=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164485645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALAH UD DIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2006
-----------------------------------------------------
Last Update Date | 04/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 SANDLAKE COMMONS BLVD SUITE 321
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-8050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-8222
-----------------------------------------------------
Fax | 407-351-8954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7300 SANDLAKE COMMONS BLVD SUITE 321
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-8050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-8222
-----------------------------------------------------
Fax | 407-351-8954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME78382
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------